Malignant ossifying fibromyxoid tumor of the calvaria: illustrative case

Ossifying Fibromyxoid Tumor of Soft Parts in the Head and Neck: A Systematic Review Addressing Surgical Management and Adjuvant Therapies

Background: Ossifying fibromyxoid tumors (OFMTs) are rare mesenchymal neoplasms with behaviors ranging from benign to malignant. Although most occur in the extremities and trunk, 9-13% are found in the head and neck, such as the oral cavity, scalp, and calvarium. Diagnosis is challenging due to their rarity and histological similarity to other neoplasms. This review synthesizes evidence on the clinical presentation, diagnostic features, and treatment outcomes of OFMTs in the head and neck, focusing on surgical management and adjuvant therapies. Methods: A systematic review was conducted according to PRISMA guidelines, with searches in PubMed/MEDLINE, Embase, Scopus, and Web of Science. Studies from 1989 to 2024 reporting OFMTs in the head and neck with clinical, histopathological, and treatment data were included. Extracted data encompassed demographics, tumor features, surgical margins, adjuvant therapy, and outcomes. Results: Forty studies with 99 patients were included. Patient ages ranged from 3 weeks to 88 years (median 47), with a male predominance (63.64%). The most common presentation was a slow-growing, painless mass. Tumors were most often found in the neck, oral cavity, scalp, and calvarium. Histopathology revealed encapsulated tumors with fibromyxoid stroma, spindle-shaped cells, and a peripheral rim of metaplastic bone in 70% of cases. Immunohistochemistry showed positivity for S-100, vimentin, and SOX10. Surgical excision was the main treatment, used in 28.28% of cases, with recurrence in 9.09% and no metastases. Adjuvant therapies, mainly radiotherapy, were employed in 15.15% of cases. Conclusions: OFMTs of the head and neck are rare neoplasms requiring multidisciplinary care. Imaging, histopathology, and immunohistochemistry are key to diagnosis. Surgical excision with clear margins remains the primary treatment, with a low recurrence rate. Adjuvant therapy may be needed for malignant or incompletely excised cases. Further research is needed to optimize follow-up protocols and assess molecular profiling for risk stratification.

A rare case of atypical ossifying fibromyxoid tumor: multiple recurrences and metastasis

Ossifying fibromyxoid tumor is a rare soft tissue mesenchymal neoplasm of unclear lineage and intermediate malignant potential, primarily arising in subcutaneous tissues of the limbs, head and neck, or trunk. Ossifying fibromyxoid tumors can be classified as typical, atypical, or malignant. While, most ossifying fibromyxoid tumors exhibit benign behavior, a subset demonstrates malignant tendencies, with a potential for local recurrence and distant metastasis. We report a case of an atypical ossifying fibromyxoid tumor in the soft tissue of the right elbow, characterized by multiple local recurrences and pulmonary metastases. This report details the clinical presentation, radiological findings, histopathological features, and therapeutic interventions, highlighting the challenges in managing this aggressive variant.

Ossifying Fibromyxoid Tumor of the Shoulder: A Case Report

Ossifying fibromyxoid tumor (OFMT) is a rare, slow-growing, mesenchymal tumor with intermediate malignant potential, predominantly affecting middle-aged individuals. Histologically, it presents as a fibrous capsule or pseudocapsule, with a complete or incomplete lamellar bone shell surrounding oval/polygonal cells within a fibromyxoid matrix. Advances in immunohistochemistry have facilitated OFMT identification, with S100 protein expression and INI-1 loss being notable features. CD10 expression is also reported in a small minority of cases. Recent studies highlight a translocation of the PHF-1 gene, proposing a possible etiology for tumorigenesis. Treatment involves wide excision, with long-term follow-up for recurrence or metastasis. In this case, a 61-year-old White male presented to the outpatient surgical office with a painless mass on his right shoulder. The patient reported that the mass first appeared three to four years prior and that it had been growing slowly since the initial presentation. On examination, the patient had a well-circumscribed, 1.5 x 1.5 cm, soft, nontender, nonmobile subcutaneous mass on his right shoulder. The mass was initially suspected to be a subcutaneous cyst based on physical exam, but surgical excision and histopathology established the diagnosis of OFMT that extended to the margins of the specimen. The patient underwent a wider excision for margins and has had a benign postoperative course. The patient was referred to dermatology and oncology for continuation of care. This case demonstrates the necessity for a thorough work-up, appropriate excision, and histopathologic examination to rule in diagnoses of lower incidence with the potential for a worse prognosis. Appropriate and timely diagnoses can guide proper screening for cancer recurrence and management.

Malignant Ossifying Fibromyxoid Tumor of the Chest Wall Metastasized to the Lung Even After Complete Resectioning of the Primary Tumor - A Case Report and a Comprehensive Review

An ossifying fibromyxoid tumor is a soft tissue neoplasm with ambiguous differentiation and low metastatic potential. Most cases involve the lower extremities, followed by the trunk, the upper extremities, and the head and neck region. It mainly arises in 40-70 years of age, and men dominate the disease's gender distribution. In the described types of ossifying fibromyxoid tumors, there are three variants: one is benign (typical), the second is malignant, which carries the risk of disease recurrence or metastases, and the third is atypical, which does not meet the criteria of either typical or malignant. Here, we present an interesting case of a malignant ossifying fibromyxoid tumor of the chest wall that metastasized to the lungs even after complete resection of the primary tumor. A 64-year-old man had a 4.0 cm malignant ossifying fibromyxoid tumor in his chest wall two years ago, and at that time, the tumor was removed entirely. On pathology review, it was noted to have 20 mitotic figures per 50 high-power fields, but no actual grade was given. He was given postoperative radiation. His recent computed tomography (CT) chest with contrast showed a new right upper lung lobe nodule measuring 0.78 cm compared to the previous contrast-enhanced CT chest six months ago. It was worrisome for metastasis. F-18 FDG positron emission tomography scan revealed sub-centimetric pulmonary nodules in the right upper lobe. Right upper lobe lung biopsy showed spindle cell neoplasm morphologically consistent with the patient's known history of malignant ossifying fibromyxoid tumor. Biopsy demonstrated fragments of the bronchial wall and alveolated lung parenchyma with a focal spindle cell proliferation demonstrating a fibromyxoid matrix. The patient was referred to the oncologist for further management. In conclusion, aggressive malignant ossifying fibromyxoid tumors can be found in atypical locations, e.g., the chest wall. Therefore, early diagnosis is crucial because of the high chances of metastasis to distant organs (including the lung) even after complete resection of the primary tumor. Even in asymptomatic patients, it is necessary to complete long-term follow-up for recurrence and metastasis surveillance of ossifying fibromyxoid tumors. Early recognition of recurrence or metastasis can decrease morbidity and mortality and improve overall organ function and patient survival.